Next steps Bryn Baxendale bryn.baxendale@nuh.nhs.uk @gasmanbax - PowerPoint PPT Presentation

Next steps Bryn Baxendale bryn.baxendale@nuh.nhs.uk @gasmanbax

How could, and should, Human Factors/Ergonomics be implemented in Health & Social Care?

How could, and should, Human Factors /Ergonomics be implemented in healthcare?

White Paper October 2018 • Provides the authoritative guide to aid understanding of how Human Factors can and should be used • Clarifies the competence and experience needed to manage effort, solve problems and make decisions

Vision for HF in Health & Social Care • Promote the integration of HF to optimise human (patients and staff) well-being and overall system performance • Build and strengthen the relationship between CIEHF and health / social care professional bodies, commissioners (care / education), policy forming bodies and regulators • Create pathways for building HF capability and capacity within health / social care in alignment with existing professional development pathways

Understanding how to use Human Factors To investigate incidents • HF approach takes a wider view to encompass root causes such as poor product design To think about systems • HF may focus on optimisation of a micro-system, but there will be clear mapping of the relationship of the micro-system with the larger systems To think about design • HF is relevant to all stages of the life-cycle from early stages of planning and design, right through to implementation and evaluation

Simple framework to start problem solving/discussion WHO WHAT WHEN WHERE HOW WHY Scope of issue/challenge/problem Investigate/explore Define stakeholders HFE methods Participatory Ergonomics, Inclusive Design Physical factors Anthropometry, Biomechanics, Postural Analysis, Vision, Hearing, Thermal comfort Cognitive factors Mental models, Individual decision making, Variability, Human-Computer Interaction , Navigation (unfamiliar environments) Organisational factors Hierarchies (professional, employer and staff-patient relationships) , Team stability, Decision making (authority, accountability, responsibility, delegation)

HSIB report 2018 Component Size Mismatch in Total Hip Arthroplasty: Surgical Never Event

Work-as-Done: Hierarchical Task Analysis

Observing practice Evaluation of the packaging for implants from 4 manufacturers • Inconsistencies in the sizes of the text for the component sizes

• https://bit.ly/2KbW1wm

Pharmaceutical Ergonomics & Human Factors Group Promoting a more explicit use of HF to support: • Product design • Systems design and performance (case studies) • Enhanced research and innovation methods Based on building a diverse and better informed multidisciplinary community

Multiple pharmaceutical stakeholders in UK How do we work together? Who is the regulator? Patient Industry Regulators (Pharmaceutical & Biotech) Professional:. GPC, Manufacturing GMC, GDC, HCPC, (industry and NMC hospital-level) Industrial: MHRA, Safety ABPI, (FDA), ISO, Information CIOMS Promotion R&D Buyers OTC*/Trial Dispensing NHS/NICE Insurance Trial (funders)

Establishing the value for Human Factors in Health and Social Care McNeish/Newell (Dstl, 2016)

Understanding the wider value of HF for healthcare People’s Allocative Economic Technical value value value Value • Service user • Increased • Clinical • Upfront costs experience performance outcomes/ • Long term • Care and efficiency targets costs (productivity) • Safety of care outcomes (sustainable • Reducing • Wellbeing • Quality of finances) waste in the • Allocative, and positive care system experiences • Reducing technical and • Eliminate people’s at work inappropriate • Culture and fragmentation value directly care and impact perception duplication economic about care value delivery

Case studies

‘ Performing Well, Feeling Well’ Taking forward Human Factors & Ergonomics (HFE) Integration in NHS Scotland Building CAPACITY and CAPABILITY Dr Paul Bowie Programme Director (Safety & Improvement) NHS Education for Scotland Paul.Bowie@nes.scot.nhs.uk Twitter @Pbnes

National HFE Development Work in Scotland • 150+ clinicians; leaders; managers; educators; risk, safety and improvement advisers; academics; Human Factors specialists/advisers, safety researchers etc • NHS Boards, Royal Colleges and Professional Bodies, Higher Education Institutions etc. • Represent simulation, NTS, team training, clinical skills, patient safety, risk, QI, governance, occupational health, clinical, management, medical device, policy communities • Four Workshops (2017-18)

Progress – Agreed Priority Areas for HFE Integration 1. Creation of a National HFE Advisory Board 2. Building Workforce Capability and Capacity 3. Learning from Events 4. Integration of HFE Principles in National Procurement and in Design of Workplaces and Care Buildings 5. Integration of HFE Design Principles with National Programmes and Initiatives – Integrated R&D/Evaluation agenda

Vision for Building Capacity & Capability • Integration of HFE principles and methods: – undergraduate teaching and postgraduate training – appraisal and CPD – simulation / NTS / clinical skills / team training – national safety and improvement programmes (e.g. SPSP) – organisational induction processes – CPD arrangements for NHS Board Members/Strategic Decision-makers – bespoke workforce education inc. managers, leaders & executives • Minimum 1 Qualified HFE Practitioner at NHS Board level • Explore CIEHF Technical/Associate Membership for key target NHS staff groups (e.g. Risk/Safety/Improvement)

Example – How HFE Could be Integrated in Postgraduate Curricula

Progress in Building C & C HFE Integration in Learning from Events 1. National / Organisational Policies on Learning from Events 2. Significant Event Analysis in Primary Care 3. Hospital Safety Reviews (Mortality & Morbidity Meetings) 4. Human Factors in Barrier Management 5. Systems Thinking for Everyday Work (STEW)

New Chair of NHS Education for Scotland ‘ Slow down and take you time to get it right ’ • HFE awareness, very supportive and ‘on board’ – will take to all national leadership networks and Scottish Government (SG) • Going straight to SG – tricky at moment • Prepare the ground - short Briefing Paper (‘essential facts’), slick presentations, informal chats with key stakeholders • Align with all major Government strategies – health AND care; stress multi-professional approach • Continue with multi incremental approach e.g. NES funding for each Board to get HFE qualified individual / building consensus with educators • Advisory Body – good idea but caveats/governance issues • Strategic plan – why, how, who, cost benefits, outcomes: take time to get this right, may take further resource

Building Capacity & Competency Hard Truths and Next Steps HARD TRUTHS • Scratched the surface but good progress • Regrouping and rethinking our approach • QI is King • Significant misunderstandings and confusion prevails • Taking a ‘hard line’ can ‘work’ • HFE initial strategy is to ‘add value’

SIMULATION BASED EDUCATION Challenges UNEXPLORED UNMEASURED 6 1 1 Lack of an overarching Minimal studies approach to patient measuring clinical safety outcomes 6 2 NON STANDARD MYTH / REAL 5 2 Failure to adopt Lack of best practice in understanding of SBE design “how “ and why /delivery 5 3 POOR CAPTURE UNPROVEN 4 3 Minimal studies Limited data on linking SBE and operational / cost 4 clinical outcomes effectiveness Bergh A-M, Baloyi S, Pattinson RC. Best Pract Res Clin Obstet Gynaecol 2015. Mcgaghie, W.C. Issenberg, SB Petrusa, E R Scalese, RJ. Medical Education,2016

Accreditation Benefits People Partnerships • • focuses on needs joined up thinking • • identifies areas for improvement joint working • builds stronger trainers and Planning workforce • forward planning Performance • formalising procedures and policies • assess performance • projecting for future growth and • reward achievement direction. • drive improvement Patient • Profile safer care • • raises awareness effective processes • builds confidence • promotes credibility with governing bodies and public.

We cannot continue to educate 21st century doctors using 19th century technologies McGaghie et al ,2014 Accreditation standards provide a common quality language and common set of expectations to point the way forward. Joint Commission International Our mission is to promote, and support simulation-based education in the pursuit of best practice for our patient, learners and members.

Developing resilience in a complex, resource constrained workplace

4 th – 6 th November 2019 10 th Anniversary